This invention relates to surgical devices and methods for dissection and removal of blood vessels from a patients body. In particular this invention relates to endoscopic vessel harvesting devices and methods.
Endoscopic harvesting of vessels is well known in the surgical field and has been the subject of a great deal of recent technological advancement. Typically, the harvesting of vessels is performed so that the vessels can be then used for procedures such as Cardio Artery Bypass Grafting (CABG). In this procedure the saphenous veins of the legs are harvested for subsequent use in the CABG surgery.
Known methods and devices for performing vessel harvesting are discussed in detail in U.S. Pat. No. 5,667,480 issued Sep. 16, 1997 and U.S. Pat. No. 5,722,934 issued Mar. 3, 1998, both issued to Knight, et al, both of which are incorporated herein by their reference.
In the traditional endoscopic harvesting devices shown in prior art FIG. 1, there is provided a hollow shaft 12 connected to a concave headpiece 16 located at the distal end of the shaft which provides a workspace 18. An endoscope 5 is typically inserted in the shaft so that the surgeon may view workspace. The leading edge of the headpiece 16 is used for dissecting the vessel from the surrounding tissue. The device may also have guides located on the underside of the device which allow for the entry of other devices such as dissectors, ligation tools, and cutting tools, into the workspace.
The traditional method for removal of a vessel section is shown in FIGS. 2 and 3. Initially an incision 3 is made and the vessel 7 is located. Then, the vessel is dissected from the surrounding tissue using the leading edge of the headpiece 16 of the device to separate the tissue from the vessel 7. At this time there is sufficient space created around the vessel 7 so that other instruments can be inserted into the incision 3 via the guides located on the underside of the device. These instruments include ligation tools for securing side branch vessels 9, vessel dissectors for performing a more complete dissection of the vessel 7 which is to be removed, and laproscopic scissors for the transection of both the side branch vessels 9 and the vessel 7 which is to be removed.
Of the know techniques for harvesting vessels and devices used for such procedures, as in the case in the above described procedure and device, the blunt dissection is performed using the headpiece 16 of the device, and then any dissection to be performed under the device must be performed using other tools which must be inserted into the patient following the original incision 3. Upon the discovery of a side branch vessel 9 still further tools must be inserted into the incision 3 for performing the ligation and transection function.
The tool exchanges of instruments, and in fact the instruments themselves complicate the procedure. They require a great deal of skill to master and no matter the skill of the person performing the procedure, the process requires a great deal of time to perform.
Accordingly, it is an object of the present invention to overcome the short comings of the prior art by providing a device which can limit the number of tools required to perform the removal of the vessel, decrease the number of tool exchanges necessary to perform the removal, and increase the efficiency and ease of operation of the entire procedure.
The present invention overcomes the limitations of the devices of the prior art by providing a means by which a user can dissect both above and below the vessel which is to be removed using only a single tool. Further, the device is capable of ligating any side branch vessels without the insertion of any extra tools.
The device of the present invention minimizes the number of tool exchanges, the total number of tools required, and increases the users efficiency.
Accordingly, a vessel harvesting device is provided. The vessel harvesting device comprises a shaft having a lumen for insertion of an endoscope therethrough. The device has a handle located on a proximate end of the shaft for allowing an operator to manipulate the device. The device is also equipped with a headpiece connected to a distal end of the shaft, the headpiece has a top and a bottom portion, these two portions define a gap that surrounds a vessel inserted therein. The two portions of the headpiece are used to dissect above and below the vessel.
The device has means for reciprocating either the top or the bottom portion relative to the other. The headpiece has a first opening for receiving a dissected portion of the vessel and one or more second openings allowing a dissected portion of a vessel to exit the headpiece. The vessel is dissected from the surrounding tissue by reciprocating one of the top and bottom portions as the headpiece is advanced along the length of the vessel.
The device may be fit with electro-surgical ligation electrodes for ligation of side branch vessels. The electrodes can be energized by an energizing means to ligate side branch vessels. The device may also be fit with a transection element. The transection element may be a raised portion of one of the upper and lower portions of the headpiece.
Also provided is a headpiece for an endoscopic vessel harvesting device. The headpiece comprises a top portion for dissecting the tissue above a vessel which is to be removed. The top portion is typically rigidly attached to the endoscopic harvesting device. The device further comprises a bottom portion for dissecting the tissue below the vessel to be removed. The bottom portion is connected to the endoscopic harvesting device by an articulated connection. The top and bottom portions define a gap into which a vessel is inserted, the top and bottom portions then surround the vessel. There is an opening in the headpiece for receiving a dissected portion of the vessel and one or more openings in the headpiece allowing a dissected portion of the vessel to exit the headpiece after dissection. The device dissects a vessel from the surrounding tissue by reciprocating the bottom portion relative to the top portion while traversing the length of the vessel.
The headpiece may be fit with electro-surgical ligation electrodes for ligation of side branch vessels. The electrodes can be energized by an energizing means to ligate side branch vessels. The headpiece may also be fit with a transection element. The transection element may be a raised portion of one of the upper and lower portions of the headpiece.
Still yet provided is a method of vessel dissection comprising a series of steps. Initially, the vessel to be harvested must be located, then an incision to expose the vessel must be made. Next, the surgeon must pre-dissect the vessel from tissue above the vessel. Then, the surgeon must pre-dissect below the vessel. Upon having a portion of the vessel dissected both above and below, a portion of the vessel which has been pre-dissected is inserted into a two piece headpiece of the vessel harvesting device so that a top and a bottom portion of the headpiece surround the vessel. Then the vessel is dissected from the tissue by projecting the top portion of the headpiece along the vessel and by simultaneously reciprocating the bottom portion of the headpiece. Dissection is accomplished by repeating the previous two steps while traversing the length of the vessel. Finally the vessel is ligated, transected and removed. When a side branch vessel is uncovered it too must be ligated and transected using the ligation and transection means of the vessel harvesting device.